New Surgical Center to Use "Miniature Access" to Address Problems in Pediatric Patients

BUFFALO, N.Y. -- Children's Hospital of Buffalo and the University at Buffalo are taking the lead internationally in pediatric surgery with the opening of a $1.5 million Miniature Access Surgical Center (MASC) believed to be the most sophisticated of its kind in the world.

The center will be devoted to performing and teaching minimally invasive surgical techniques for infants and children, many of which have become standard for adults, but only in recent years have been used with children.

Children's will unveil the new center at a ribbon-cutting ceremony at 3 p.m. Saturday.

"It's the only such facility at a free-standing children's hospital in North America," said Philip Glick, M.D., Children's surgeon-in-chief, professor and chair in UB's Department of Surgery and executive director of the center. "We can do the most cutting-edge surgery, teaching, training and research -- both basic science and R & D -- right here."

The center will be linked via fiber optics to a new Miniature Access Surgery Teaching, Training and Research (MASTTAR) Center in the Biomedical Research Building on UB's South (Main Street) Campus, where students ranging from those in the UB School of Medicine and Biomedical Sciences to surgical fellows will be able to view and practice current techniques, develop new procedures and test new instruments.

The $900,000 teaching center is a component of UB's bioinformatics research program and is being supported by the university.

"Almost everything you can do with 'open access' you can do with miniature access," Glick said. Children's chose the term "miniature access" rather than "minimally invasive" because it seemed more appropriate for its diminutive patients. "Many of these operations were created or modified here," he added.

One such operation Glick and colleagues developed corrects a congenital disorder of infancy or early childhood called Hirschsprung's disease. In this condition the bowel doesn't function properly, resulting in a dilated, thickened bowel and severe constipation.

Using miniature-access techniques, Glick and colleagues compressed surgery that formerly had to be done in two-to-three stages, each requiring three-to-five days of hospitalization, into one operating day, plus one pre- and one post-surgical day. The innovation eliminates the need for a colostomy and dramatically reduces pain, suffering, scarring, hospital stays and recovery time.

The charge to restructure its approach to pediatric surgery at Children's was led by Glick and faculty members in the UB Department of Surgery. Inspired by results he observed and began using in the early 1990s, Glick lobbied for a fully committed miniature access surgery program.

"It took about five years for the entire surgical staff to decide to convert to miniature access techniques," Glick said. "We envisioned the concept of our MASC and its teaching component two years ago. It took 18 months to create the dream."

Minimally invasive surgery is the antithesis of the traditional "open access" approach, in which a surgeon works on the patient through an incision in the body large enough to accommodate human hands wielding scalpels, suction tubes or other instruments. A large open wound brings with it collateral tissue damage, risk of infection, pain and a lengthy recovery, in addition to permanent, often prominent scars.

The ability to perform surgery through small "ports" became possible with the invention of the endoscope, meaning literally "to view within." An endoscope is a rigid or flexible tube a few centimeters in diameter equipped minimally with a miniature light and camera at its end. Ports inserted strategically through small incisions allow tiny instruments to be introduced into the surgical site, enabling the surgeon to perform practically any surgical task.

Endoscopic surgery for adult conditions has been practiced since the late 1980s, but it rarely was used with babies and children.

Operations performed here can be telecast to any site in the world equipped for teleconferencing. Glick foresees his team conducting local, national and international clinics in miniature access surgery for physicians, students, residents, nurses and technicians. They also will be able to assist at surgeries being conducted at any surgical site equipped to transmit real-time video to the MASC.

The center will attract many patients and surgical fellows to Buffalo, Glick predicts. "We expect a lot of visitors. We expect to get referrals from all over the world. Right now we have fellows from the Philippines and Argentina."

Marc Levitt, M.D., UB assistant professor of surgery and pediatrics, will be medical director of both the MASC and MASTTAR.

The MASC was made possible by grants from the Children's Hospital Foundation, Stryker Communications Corp., Ethicon Endo-surgery, Inc., Steris Corp. and Berchtold Corp.